Biggest denial reason had nothing to do with diagnosis coding.
It appears that ICD-10 really will be implemented this year, with a recent Congressional hearing confirming that the government doesn’t plan to push back the new diagnosis coding system any further than it already has been—and with those plans full steam ahead, CMS revealed that its recent end-to-end testing period returned positive results.
The agency processed 14,929 test claims during the Jan. 26 to Feb. 3 testing period, from 661 participating providers. An overwhelming majority of claims—81 percent—were accepted through the system, and the remaining claims were rejected for three main reasons, as follows, according to the most recent statistics released by CMS:
Question: I have three questions about using 99051:
1. Should we use 99051 in addition to the E/M code for that service (scheduled hours)?
2. What is the definition of “basic service?”
3. Would you provide references for using this code?
When coding and billing experts continually remind practices to “put medical necessity first,” they aren’t just blowing smoke. Without a medically necessary reason to perform your services, you could be facing jail time.
A New York physician is learning that lesson the hard way this week after pleading guilty to billing Medicare for $14.2 million in claims for medically unnecessary treatments, the Department of Justice reported on March 6.
Ophthalmology practices, prepare for a 2 percent cut to Medicare payments.
When CMS announced on Halloween that it had published the 2015 Physician Fee Schedule Final rule, many practices were a bit spooked to review it — but fortunately, the finalized version of the document doesn’t differ too wildly from the proposal that the agency published earlier this year. Read on to discover several of the most impactful items from the 1,185-page document.
No Negative Conversion Factor — Yet
When it comes to the conversion factor, the fee schedule had some good news. Because the Protecting Access to Medicare Act won’t allow any cuts in the conversion factor through March 31, 2015, CMS has finalized the conversion factor of $35.8013 through that date. Starting April 1,
Careful: Crosswalks can be your best friend — or worst nightmare.
ICD-10 codes are coming soon, and they’re a lot more detailed than ICD-9. Use the following examples to get a feel for the higher granularity you’re looking at for common rehab diagnoses.
1. Flaccid Hemiplegia
An OT documents a visit for a right-handed client with flaccid hemiplegia impacting the right side. “In ICD-9, the therapist could code the treatment diagnosis of 342.01 (Flaccid hemiplegia and hemiparesis affecting the dominant side),” says Jeremy Furniss, MS OTR/L, coding and payment specialist for the American Occupational Therapy Association (AOTA). “The ICD-10, however, looks at dominant and non-dominant as well as laterality, so the ICD-10 code is G81.01 (Flaccid hemiplegia affecting right dominant side).
Question: We have been facing challenges for reporting bilateral procedures like injection codes 64483 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single level) and 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed). Is it better to report modifiers LT and RT to each injection or append modifier 50 to one injection code?
If you were busily trying to prepare your meaningful use attestation for the 2014 reporting period, CMS has offered you a bit of breathing room. The deadline for attestation is now March 20, giving you three more weeks of prep time than you had before to attest to meaningful use. In addition, CMS is extending the EHR reporting option for PQRS to March 20 as well.
As long as you comply with the electronic health record (EHR) reporting option rules by 11:59 pm EST on March 20, you’ll be in the clear for meaningful use compliance.
Don’t fall for DSAP diagnosis trap.
Your surgeon treats a patient with a fairly large, circular keratotic lesion on a patient’s right ankle. That sounds like a simple enough case, but read on to see what trials await you as you zero in on the proper diagnosis and procedure codes.
Focus on Diagnosis
The patient presents with a 0.9 cm lesion on the right ankle that appears hyperkeratotic. Suspecting a wart (078.1, Viral warts) or actinic keratosis (702.0, Actinic keratosis), the surgeon treats the lesion.
The patient returns three months later because the lesion has returned. It is now 1.3 cm in diameter and consists of a “plaque” surrounded by a ridge-like border. The surgeon removes the lesion and sends the specimen to pathology. The pathology report reveals a classic cornoid lamella, which is a thin vertical column of parakeratosis in the epidermal stratum corneum that makes up the outer “ring” of the lesion.
If you’re feeling hesitant to adapt to ICD-10, it’s time to start planning.
With just six months left until use of ICD-10 codes is mandatory, there are still some practices that are feeling more defiant than compliant. If you remain opposed to the ICD-10 transition, CMS offers a stark reality in its recent website FAQs, letting you know that you simply won’t be able to collect from the program if you turn your back on the new coding system.
If you don’t switch to ICD-10, your claim “cannot be processed,” the agency bluntly explains. Of course, this means that any services you submit to Medicare, Medicaid or any other payer covered by the HIPAA laws will have to transition to ICD-10 or else they won’t get reimbursed for their charges.
Question: I’ve heard that the mass of a uterus is important for choosing the proper code, so how do I use that information in my code selection for the pathologist’s uterus exam?